(468) Eclampsia Recurrence in the Modern Era: A 10-Year National Cohort Study

To determine the recurrence risk of eclampsia in subsequent pregnancies. While the recurrence of preeclampsia is well-documented, there is limited data regarding the recurrence of eclampsia. Understanding this risk is critical for counseling and management of affected patients.

Study Design:

This retrospective cohort study utilized the TriNetX research network which includes data from a diverse group of national healthcare organizations. Patients with a diagnosis of eclampsia between 2015 and June 2025 and at least one subsequent pregnancy were included. A total of 12,362 patients met inclusion criteria. Recurrence of eclampsia was assessed and stratified by the number of subsequent episodes. Patients were also screened for development of preeclampsia and HELLP syndrome in future pregnancies.

Results:

Of the 12,362 patients with an index pregnancy complicated by eclampsia and a subsequent pregnancy, 2,641 (21.4%) experienced recurrent eclampsia. Additionally, 886 (7.2%) had three episodes, and 1,102 (8.9%) had four or more episodes. In total, 4,629 patients (37.4%) experienced recurrent eclampsia. Among the cohort, 6,983 patients had no prior diagnosis of preeclampsia; of these, 2,298 (32.9%) developed preeclampsia in a subsequent pregnancy. Further, 1,016 (14.5%) experienced preeclampsia in two subsequent pregnancies, 471 (6.7%) in three, and 761 (10.9%) in four or more pregnancies. Overall, 4,546 patients (65%) developed preeclampsia in at least one future pregnancy. Of 13,359 patients without a prior diagnosis of HELLP syndrome before the index eclampsia event, 718 (5.4%) developed HELLP in one subsequent pregnancy, 378 (2.8%) in two, 175 (1.3%) in three, and 252 (1.9%) in four or more subsequent pregnancies.

Conclusion:

Recurrent eclampsia occurred in over one-third of patients with a prior diagnosis. Additionally, two-thirds experienced preeclampsia and nearly 10% developed recurrent HELLP syndrome in subsequent pregnancies. These findings highlight the need for anticipatory counseling, risk stratification, and close surveillance in patients with a history of eclampsia.